3.1 The feeding decision
What is most influential?
Less well known are psychosocial variables. Researchers found that maternal attitudes are better predictors of feeding method than are sociodemographic factors,1 and that a woman's prenatal intention was a stronger predictor than the standard demographic factors combined.2 Fathers' attitudes also influence maternal decisions.3
In a study of women who were already breastfeeding 95.5% gave breastmilk as being better for the baby as the major reason they chose to breastfeed, with convenience for the mother another common reason. Another researcher4 explored why both breastfeeding and artificial formula-feeding mothers chose their method of feeding. They found ...
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Mothers chose to feed artificial infant formula
- not because they embraced artificial infant formula-feeding, rather that they rejected breastfeeding
- found breastfeeding embarrassing
- feared the pain or discomfort
- felt it limits freedom and social life
- were concerned that the father would not be involved
- but acknowledged that human milk is better for the baby
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Mothers who chose to breastfeed had the following in common
- a positive attitude toward breastfeeding and human milk
- considered human milk to be healthier or 'better' for babies than artificial infant formula
- felt breastfeeding was more natural
- felt it resulted in better bonding or closeness with the baby
- and their self-confidence was linked to longer duration of breastfeeding
• breastfeeding in public,
• combining breastfeeding and working, and
• management of breastfeeding by health professionals5
Pregnant women are influenced in their attitude towards breastfeeding and will tend to adopt similar attitudes and opinions to that of their health care provider. Women who are encouraged to breastfeed by their doctor or nurse are more than four times as likely to initiate breastfeeding as women who do not receive encouragement.6
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![]() Play your part...This is an indication of the mother's respect for her health provider's opinion, and the responsibility that rests on your shoulders to be a positive influence on pregnant women at a time when they are so open to receiving information.
You have a very important role to play in encouraging a positive breastfeeding attitude. |
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![]() Influencing attitudes Look again at the reasons mothers have given for them to artificially feed, and what mothers' concerns about breastfeeding are. Be aware that these personal attitudes may exist for some women. |
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Guilt and not breastfeedingThis is a good opportunity for you to re-read about how feelings of guilt develop in the infant feeding decision. Understanding this will assist you to communicate effectively with pregnant women.
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But not everyone can breastfeed!
For other infants breastmilk may be contraindicated.8 These include:
- Infants with inborn errors of metabolism who require special formulations:
- classic galactosemia
- maple syrup urine disease
- phenyloketonuria, though some breastfeeding is possible, and desirable, under careful monitoring
- Mothers who may need to avoid breastfeeding
- HIV positive, but only when replacement feeding is acceptable, feasible, affordable, sustainable and safe
- Mothers who may need to avoid breastfeeding temporarily
- severe illness, eg sepsis
- herpes simplex virus (HSV-1) on mother's breast where it will contact the infant's mouth (though breastfeeding from the other breast would not be contraindicated)
- medication usage: cytotoxic chemotherapy; radioactive iodine-131 (safer alternatives are available); excessive use of topical iodine, eg on open wounds or mucous membranes; some sedating psychotherapeutic drugs, anti-epilepsy drugs, opioids though safe alternatives are usually available; drugs of addiction
What should I remember?
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Self -test quiz
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Notes
- # Dungy CI et al. (1994) Maternal attitudes as predictors of infant feeding decisions
- # Donath SM et al. (2003) Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: a cohort study
- # Freed GL et al. (1993) Effect of expectant mothers' feeding plan on prediction of fathers' attitudes regarding breast-feeding
- # Brodribb W et al. (2007) Identifying predictors of the reasons women give for choosing to breastfeed.
- # McIntyre E et al. (2001) Attitudes towards infant feeding among adults in a low socioeconomic community: what social support is there for breastfeeding?
- # Lu MC et al. (2001) Provider encouragement of breast-feeding: evidence from a national survey
- # Spence JC (1938) The Modern Decline of Breast-Feeding
- # World Health Organization (1998) Evidence for the ten steps to successful breastfeeding